Misinformed L&D Nurses

[PiesandAbrosmama]

So I've noticed many familiar senerio's where a knew mom trying to breastfeed gets discouraged by well intended misinformed breastfeeding information at the hospital.

Mama is trying to get newborn to latch, nurse comes in (and I'm not saying intentionally sabotages the situation), but sets up "ideal" parameters of how to nurse and for how long. Add that pump in-between each feeding and Mama starts to feel defeated and begins to think she isn't producing enough. Often because when she pumps nothing comes out yada yada, she is stressed out by feeding every 2 hours and pumping in-between and she begins to supplement with formula.

Where are these nurses getting educated? How can we advocate for well informed nursing staff in all L & D?

Naturally I say to the mama's "your doing awesome, yes it's a little awkward at first but your both learning and it will get better. No need to pump if baby is eating every two hours, if babe is comfy at the breast keep him there while your feeding you can get the other side next feeding. Check for those daily diapers how many wets? How many bowels?"

I think many women (me included) find it much harder to get anything out of a pump, but I can be sure baby is eating and getting enough because A. She's growing B. She's pooping and peeing and C. She is content between feeding and ready after several hours.

Anyway I just want to know if I'm the only one constantly hearing about these interventions? And what do you all think needs to happen to support women better at the hospital in terms of breastfeeding support!

[by-the-lake]

I must, of course, comment on this. I am a L&D nurse and have done none of those things you describe. Do these things occur? Of course. Registered nurses are not given one way to educate about breastfeeding, per se. Even our certified lactation consultants have differing ways of doing things.
The underlying issue could be two things. One has to do with the mainstream attitude and misinformation on breastfeeding in general. The other is the fact that hospitals are full of interventional devices, such as pumps. Birth centers and home births are not.
It is crushing to many new mothers the constant misinformation about breastfeeding. However, the problem runs much deeper than nurses in the hospital.

[PiesandAbrosmama]

by-the-lake I totally agree it's not ALL L & D Nurses. I myself am in school for nursing going for my CNM .
I also realize much misinformation in general about breastfeeding is throughout the entire system and cultural, however, I think those first moments are so crucial in setting up this attitude/feeling about the nursing relationship between mom and babe and should be regarded with much caution and very well informed help. It's those comments that stay in a new mommies head and play round and round "but she said. . . ." yes it's not all on the shoulders of one L & D nurse but shouldn't it not happen at all? Shouldn't we have a more universal education for all birth professionals to understand the emotional and certainly the physical process? Should it really be just a luck of the draw when it comes to quality care that is dealing what could be the make or break experience for an entire mother baby relationship?
I guess what I'm trying to get at is how can we make the system less flawed, more breastfeeding knowledgeable ect.

[maybemom05]

I think it depends almost on luck of the draw. I had 2 hospital births, and had relatively positive experiences with LCs and L&D nurses in both places. I think so much of it goes back to education of mothers before delivery. Has mom been able to attend at least 1 LLL meeting? Does she know other nursing moms? What was her labor like?

FWIW, I tell all expecting mothers to bring a book on breastfeeding with them to the hospital - Womanly Art, the Nursing Mother's companion, etc. This is useful on a few levels: 1) staff sees the book in the room, and it sends a non-verbal message that this mom is serious about breastfeeding, serious enough about it to research things before hand 2) it empowers mom to ask questions if she's told something that sounds a bit "off" 3) it gives mom a chance to answer her own questions without involving the nursing staff - which sometimes can just be better.

[happysmileylady]

One other thing to consider is what the mamma HEARS vs what the nurse actually says.

[jessjgh1]

asleep kiddo on me, but I'd have to say this happened to me, but not out of bad info or ignorance/lack of training.
Many nurses were well meaning, many contradicted one another- it was bewildering and I didn't know whose advice to take. This was in a pro-breastfeeding environment, too and with one lc who later was EXTREMELY wonderful and is top notch, very respected (and who I worked through all of my problems with, eventually). In my case it was information overload and a lack of consistent followup or a unified approach

Jessica

[akind1]

My breastfeeding in the hospital was as hands-off and non-interventional as my labor was hands-on and interventionist (had a c-section after induction with failure to progress beyond 7 cm). The LC showed me the football hold (which I used maybe twice) said latch looks good, and came back one more time during the hospital stay while my midwife was also there and the baby was eating, and just observed and said "call with questions"

this was ok I guess. I actually got far more help from my Dr - the one who did the last-minute c-section - 's nurse - she was a nursery nurse before she became an OB office nurse and she was wonderful and answered all my questions and had a great attitude (is it ok if I'm not hungry? what do I do about engorged breasts=flat nipples?) the LC called and left me 2 voice mails in the early weeks, but as we never really established a relationship, I didn't call back.

I think the biggest source of misinformation can be pediatricians. I have friends whose ped's tell them that a EBF baby can and should go 10-12 hours a night without waking or needing to eat. (this at between 2 and 4 months, no later than 6), that dream-feeding is a crutch, that solids should be begun at 4 months, and lots of other things that just really aren't "true". That said, my ped is in the same practice as hers and he hasn't suggested any of these things. but he is much younger and has a newborn at home.

I think the best thing you can do is just be supportive of your friends and let them know that they *can* breastfeed, and if one of the nurses or someone's suggestions isn't helpful or would be detrimental, let them know, but also explain why and what would be better option for them.

[jessjgh1]

Getting back to the point, which was that these things do happen, AND what can be done....

Originally Posted by by-the-lake

I must, of course, comment on this. I am a L&D nurse and have done none of those things you describe.

I wanted to say earlier, but couldn't, that this made me think alot. I don't think as an L&D nurse you could really say for sure you never made that impression on your patients. It can be so overwhelming and intimidating for new moms that even well-meaning interactions can be confusing or mis-interpreted. I'm pretty sure all the nurses I had thought they had been helpful, and some were- but the entire situation was mostly confusing.

Do you really get feedback to know how your team is doing to promote breastfeeding? Do you know which moms have long-term success? Which ones leave the hospital breastfeeding? Does your hospital have free LC support, breastfeeding support groups, and other services (or refer out?)?

I know my hospital had exit surveys and I didn't fill mine out for months, because I was just too emotional about the experience to tackle it, but after I did, I got a phone call back and was questioned at length about my experience. I was told that they could see there was a problem and were looking for a way to change so that there was more communication between nurses & LC's and less conflicting 'advice'. Of course, who knows what happened.

I wouldn't have been able to fill out the exit survey properly if I had tackled it within a week or so of leaving the hospital, so I think both immediate and follow up surveys might be helpful. I'm not sure the survey itself was particularly done well, I now could fill it out with many more comments about my birth, for example. It has taken many years to dissect and understand all the little pieces that contributed to the birth that led to problems breastfeeding, etc. Most hospitals are not going to be interested in the same points that I'd be interested in (natural birth, breastfeeding, promoting empowerment, bonding, etc.)

In addition, there are standards that hospitals can strive for and I'm sure the support of nurses for these would help to promote a more positive breastfeeding atmosphere. The WHO's baby friendly or CIMS mother friendly initiatives are 2 that come to mind.

Making sure hospitals have breastfeeding support groups or information about LLL or other local supports would be excellent... Knowing which pedi's are pro-breastfeeding, or which pedi's rely on their PA or if they are lucky enough to have LC's.... For example, my pedi was part of the problem, but if I had been in touch with _his_ PA, SHE knew her b'feeding stuff and wouldl have been MUCH more helpful.

There are probably many more things L&D's can do.... I bet ICBLC's or LLL or the other organizations have created some ideas for modelling/standards, etc.

Jessica

[annettemarie]

I am going to move this back to Lactivism (sorry!) but am asking that you all please keep the focus on breastfeeding advocacy and not on venting about L&D nurses you might have encountered. Thanks all!

[PiesandAbrosmama]

Jessica- exactly getting to the point I'm trying to convey here. How can the system work better to support mothers with well informed, unified, and compassionate care? Yes it's personal responsibility to be "prepared" if possible for your breastfeeding experience. The reality is so much more when the time actually comes. Furthermore I'm always plugging LLL and mother support, but I think that "medical knows best" impression really sticks to a new mom. So again not having answers myself but looking at some ideas others might have.

[by-the-lake]

[QUOTE=PiesandAbrosmama;15445800]by-the-lake I totally agree it's not ALL L & D Nurses. I myself am in school for nursing going for my CNM .

Me too!!!!

[by-the-lake]

Originally Posted by jessjgh1

Getting back to the point, which was that these things do happen, AND what can be done....

I wanted to say earlier, but couldn't, that this made me think alot. I don't think as an L&D nurse you could really say for sure you never made that impression on your patients.( Yes, I can. I have never done those things described in the OP, reread if nessacery) It can be so overwhelming and intimidating for new moms that even well-meaning interactions can be confusing or mis-interpreted. I'm pretty sure all the nurses I had thought they had been helpful, and some were- but the entire situation was mostly confusing.

Do you really get feedback to know how your team is doing to promote breastfeeding? Do you know which moms have long-term success? Which ones leave the hospital breastfeeding? Does your hospital have free LC support, breastfeeding support groups, and other services (or refer out?)?

I know my hospital had exit surveys and I didn't fill mine out for months, because I was just too emotional about the experience to tackle it, but after I did, I got a phone call back and was questioned at length about my experience. I was told that they could see there was a problem and were looking for a way to change so that there was more communication between nurses & LC's and less conflicting 'advice'. Of course, who knows what happened.

I wouldn't have been able to fill out the exit survey properly if I had tackled it within a week or so of leaving the hospital, so I think both immediate and follow up surveys might be helpful. I'm not sure the survey itself was particularly done well, I now could fill it out with many more comments about my birth, for example. It has taken many years to dissect and understand all the little pieces that contributed to the birth that led to problems breastfeeding, etc. Most hospitals are not going to be interested in the same points that I'd be interested in (natural birth, breastfeeding, promoting empowerment, bonding, etc.)

In addition, there are standards that hospitals can strive for and I'm sure the support of nurses for these would help to promote a more positive breastfeeding atmosphere. The WHO's baby friendly or CIMS mother friendly initiatives are 2 that come to mind.

Making sure hospitals have breastfeeding support groups or information about LLL or other local supports would be excellent... Knowing which pedi's are pro-breastfeeding, or which pedi's rely on their PA or if they are lucky enough to have LC's.... For example, my pedi was part of the problem, but if I had been in touch with _his_ PA, SHE knew her b'feeding stuff and wouldl have been MUCH more helpful.

There are probably many more things L&D's can do.... I bet ICBLC's or LLL or the other organizations have created some ideas for modelling/standards, etc.

These things are great ideas. But the reality of it is hospitals are businesses. We currently have an after care clinic in which moms and babes come back as often as needed for breastfeeding support and assistance. It is free. Administration decided just this year they would rather have that lactation nurse staff the floor and close the clinic for 3 days per week. We have been told maternity care is not a money maker and we cannot justify keeping the lactation clinic open in dollars and cents for the hospital. It is not for passion or love of breastfeeding things are not as good as they should be. It really comes down to whose interest gets the presidence. It really is a culture problem. We have attempted Baby Friendly status with our peditrician group, and were shot down by administration because it was 'too expensive'.

This is why birth should not really take place in the hospital setting. This is why I am working at my CNM to get OUT!!!!

Responses bolded
~Erin

[PiesandAbrosmama]

Interesting insight Jessica. So it's ironic really that it's too "expensive" for correct support for mama's but in the long run formula feeding costs hundreds of thousands more in health costs and actual costs.
As health care reform happens and we see legitimate ways to save money, like helping women really achieve breastfeeding for at least the first 12 months and see a shift to those ideas, then maybe we'll see change?

[sapphire_chan]

nvm, question was addressed upthread.

[Heba]

This is why the UNICEF Baby Friendly Initiative is SO important. Are there many Baby Friendly hospitals in your area?

[Heba]

Just noticed your comment about BFI certification being deemed to be "too expensive" - that is so sad

[mamabadger]

Originally Posted by by-the-lake

The underlying issue could be two things. One has to do with the mainstream attitude and misinformation on breastfeeding in general. The other is the fact that hospitals are full of interventional devices, such as pumps. Birth centers and home births are not.
It is crushing to many new mothers the constant misinformation about breastfeeding. However, the problem runs much deeper than nurses in the hospital.

Very good points. The hospital environment itself tends to direct the way BF is approached or supported.
Just as some say most obstetricians have never seen a normal birth, it might be said that most hospital nurses have never seen normal breastfeeding. They identify what happens in the hospital as normal, and if that includes 90% of newborns having trouble nursing or needing supplements, then that is defined as normal. BF might be impeded by drugs in labour, separation of mother and newborn, swaddling, eye drops, lack of privacy, etc. Yet because this is "normal" for a hospital, it would not occur to a nurse to say, "They really messed up BF with XYZ interventions, let's see if we can get things back on track." Instead they mostly tell mothers the baby is too tired to nurse, or needs more training on how to latch on, or needs supplements until the milk comes in, or whatever, and that these problems are normal and expected. HCP's could be much better at supporting BF mothers is they became more consciously aware of what they do to interfere with BF in the first place.

[haurelia]

Originally Posted by mamabadger

Very good points. The hospital environment itself tends to direct the way BF is approached or supported.
Just as some say most obstetricians have never seen a normal birth, it might be said that most hospital nurses have never seen normal breastfeeding. They identify what happens in the hospital as normal, and if that includes 90% of newborns having trouble nursing or needing supplements, then that is defined as normal. BF might be impeded by drugs in labour, separation of mother and newborn, swaddling, eye drops, lack of privacy, etc. Yet because this is "normal" for a hospital, it would not occur to a nurse to say, "They really messed up BF with XYZ interventions, let's see if we can get things back on track." Instead they mostly tell mothers the baby is too tired to nurse, or needs more training on how to latch on, or needs supplements until the milk comes in, or whatever, and that these problems are normal and expected. HCP's could be much better at supporting BF mothers is they became more consciously aware of what they do to interfere with BF in the first place.

As an OB nurse, I've had countless conversations with colleagues about what happens to mothers and babies in the hospital, and how the way we're born impacts a whooooole lot of things. Sadly, there is a lot of misinformation about such and such intervention being "safe." Well, safety and normalcy are two different things, and the hospital culture does NOT promote normalcy.

In addition, I think the Baby Friendly certification could go a loooong way toward standardizing breastfeeding education in hospitals and increasing good outcomes for breastfeeding pairs. It requires that any provider, be it bedside RN, aide, pediatrician, etc, receive the same training in breastfeeding support. If all who come into contact with the mother/baby pair are on the same page with their training, then the information and support provided will be uniform and accurate.

What some have said about institutions declining to certify in BFI is, sadly, all too common. Hospitals are in business to make as much money as possible. I worked in a large university hospital birth center. The BFI training for our birth center personnel was projected to cost around $400,000. Bear in mind, this hospital was constructing a billion dollar new women's and children's hospital. Could there be room in the budget for the BFI training and certification? Nope! Could there be room in the budget for construction of facilities suitable for the projected 50% c/s rate? Yep!

However, that monetary factor *is* good in that we, as consumers, can vote with our healthcare dollars. Ask lots of questions, and if you have a choice of doctors and hospitals, find the one that puts more resources toward the things that are important to you as a consumer of health care. Call the nurse manager of the birth center/OB floor, or the director of OB services to ask about the Baby Friendly certification, and if they're pursuing it, or if they intend to, or if they've considered it.

[texmati]

I gave birth in a baby friendly hospital, and although a lot of things were less than ideal, the attitude towards breastfeeding was excellent.

Even though we were having an awful time breastfeeding, not one nurse even breathed the word bottle in my presence. baby was latched on for the first feeding, before i was really out of anesthesia. An LC came every feeding between 8-5 to help me feed the baby, and switch sides. Even with all that I had read, hoped, ect, I was so, so, so very defeated pp, that if it werent for the staff, my poor DS would be getting formula out of a bottle as we speak!

[phathui5]

Originally Posted by Heba

This is why the UNICEF Baby Friendly Initiative is SO important. Are there many Baby Friendly hospitals in your area?

We have one in our area. The others aren't Baby Friendly.